Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH 8882 | FL |
NPI | 1003985052 |
---|---|
Provider Name | Dr. Robert Court Bock |
First Address | St Petersburg, FL 33704-1202 |
Second Address | St Petersburg, FL 33704-1202 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 31/08/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
89867 | BLUE CROSS BLUE SHIELD (01) | FL |